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Quality Improvement Manager
2 months ago
Job Summary:
The Manager, Quality Improvement will oversee the day-to-day operations of quality improvement and health equity activities at Santa Clara Family Health Plan. This includes oversight of Healthcare Effectiveness Data and Information Set (HEDIS) reporting, Medicare Stars Program, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Health Outcomes Survey.
Key Responsibilities:
- Collaborate with internal business units and external providers and community partners to drive quality improvement projects at the health plan.
- Develop and monitor key performance indicators, metrics, programs, and initiatives related to quality improvement activities.
- Manage the QI and Health Equity and Star programs, including Performance Improvement Projects (PIPs), Quality Improvement Projects (QIPs), HEDIS, quality analytics, and other required regulatory submissions.
- Manage other projects as needed that support quality outcomes and organizational goals.
- Manage vendors and contractors used for QI and Star programs to ensure they perform according to contract compliance and effectively meet plan needs.
- Identify issues, trends, and opportunities to improve quality or better assist departments; develop recommendations and implement the same relative to identified issues, trends, and opportunities.
- Maintain a thorough knowledge of applicable laws and regulations to effectively monitor and ensure compliance with CMS, DHCS, DMHC, and other applicable agency and program requirements.
- Develop policies and procedures to ensure adherence to contractual, legal, and regulatory requirements.
- Attend off-site meetings or events as necessary.
Requirements:
- Bachelor's Degree in Health Administration, Public Health, Nursing, or related field; or equivalent experience, training, or coursework.
- Minimum two years of experience with the duties and responsibilities described above, including experience running a full cycle of HEDIS.
- Minimum two years of work experience with a managed care plan, Medi-Cal, and/or Medicare Star programs, hospital, Federally Qualified Health Centers, Indian Health Centers, provider group, Management Services Organization, Independent Physician Associations, health system, or clinic.
- Demonstrated project management and data analysis skills.
- Strong understanding of quality improvement methodologies.
- Ability to think creatively and work strategically to help drive innovative solutions yielding measurable results to the organization.
- Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff.
- Strong working knowledge and proficient with Microsoft Office applications, and the ability to operate all applicable software.
- Excellent oral and written communication skills, including the ability to express oneself clearly and concisely.
- Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, and staff.
- Self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast-paced, dynamic environment with a high level of ambiguity.
- Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision.
- Ability to think creatively and work strategically to help drive innovative solutions yielding measurable results to the organization.
- Ability to gather and analyze data, organize and write reports, and organize work efficiently.
- Ability to take initiative and exercise good judgment when making decisions within the scope of the position.
- Ability to maintain confidentiality.
- Ability to travel for in-person off-site conferences, meetings, or events.
- Ability to comply with all SCFHP policies and procedures.
- Ability to perform the job safely with respect to others, to property, and to individual safety.
- Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from off-site meetings or events; or ability to use other means of transportation to attend off-site meetings or events.
